Department of Children's Diseases and Pediatric Surgery, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
Front Immunol. 2024 Mar 6;15:1363410. doi: 10.3389/fimmu.2024.1363410. eCollection 2024.
Pulmonary endotheliopathy and microvascular immunothrombosis play a key role in acute COVID-19. Moreover, persistent endotheliopathy and heightened coagulability frequently occur in individuals recovering from COVID-19, suggesting the intriguing possibility of their role in the development of long COVID. The aim of our study was to investigate the coagulation profile in patients with COVID-19 based on age and their role in the development of long COVID.
We conducted a prospective single-center cohort study from September 2022 to August 2023. The study involved 190 patients younger than 18 years who were hospitalized at the Ternopil City Children's Hospital, Ukraine due to COVID-19. Patients underwent determination of coagulation profile in addition to the general clinical examination. After discharge from the hospital, patients were monitored for the presence of long COVID symptoms. Among the 157 participants who consented for follow-up, 62 patients (39.5%) had long COVID symptoms according to the WHO definition, while the rest (95 patients) did not have symptoms of long COVID (fully recovered).
The study revealed the normal count of platelets in the majority of patients (86.8%), whereas abnormalities in the coagulation profile were revealed in 94.5% of children with COVID-19, and these changes were age-dependent. The patients were mostly presented with increased activated partial thromboplastin time (69.1%), prothrombin time (PT) (39.8%) and D-dimer (45.0%). There was no significant difference between the median of platelet levels and coagulation profile indicators between the groups with long COVID and recovered. Among children who developed persistent long COVID symptoms there was a statistically higher percentage of abnormal PT values (53% versus 36.1%, p=0.0432), with no significant differences in other coagulation profile indicators. Abnormal PT along with female gender, comorbidities, especially allergic pathology, nutritional disorder, including obesity, were determined as potential risk factors of the long COVID development (Odds ratio - 2.0611; 95% 1.0179-4.1737, p=0.0445).
The study highlights the need for more extensive research into the coagulation profiles of pediatric populations, considering age-specific factors. This could enhance our understanding of thromboinflammation in COVID-19 and its potential contribution to the development of persistent symptoms.
肺血管内皮病和微血管免疫血栓形成在急性 COVID-19 中起着关键作用。此外，在从 COVID-19 中康复的个体中经常发生持续的血管内皮病和升高的凝血活性，这表明它们在长 COVID 发展中的作用具有引人入胜的可能性。我们的研究目的是根据年龄调查 COVID-19 患者的凝血谱及其在长 COVID 发展中的作用。
我们进行了一项前瞻性单中心队列研究，从 2022 年 9 月至 2023 年 8 月，研究纳入了在乌克兰特尔诺皮尔市儿童医院因 COVID-19 住院的 190 名年龄小于 18 岁的患者。患者除一般临床检查外，还进行了凝血谱测定。从医院出院后，监测患者是否存在长 COVID 症状。在 157 名同意随访的参与者中，根据世卫组织的定义，62 名患者（39.5%）有长 COVID 症状，其余 95 名患者（95 名）没有长 COVID 症状（完全康复）。
研究显示，大多数患者的血小板计数正常（86.8%），而 94.5%的 COVID-19 患儿凝血谱异常，这些变化与年龄有关。患者主要表现为活化部分凝血活酶时间延长（69.1%）、凝血酶原时间延长（39.8%）和 D-二聚体升高（45.0%）。长 COVID 组和恢复组之间血小板水平和凝血谱指标的中位数无显著差异。在持续性长 COVID 症状发展的儿童中，PT 值异常的百分比具有统计学意义（53%比 36.1%，p=0.0432），其他凝血谱指标无显著差异。PT 异常与女性性别、合并症（特别是过敏病史）、营养障碍（包括肥胖）被确定为长 COVID 发展的潜在危险因素（比值比 2.0611；95%置信区间 1.0179-4.1737，p=0.0445）。
该研究强调需要针对儿科人群进行更广泛的凝血谱研究，考虑到年龄相关因素。这可以提高我们对 COVID-19 中血栓炎症的理解及其对持续性症状发展的潜在贡献。
